298 THE EAR
nerve may be exposed causing paralysis, but in most cases the initial symp-
toms are pain and deafness. There may also be tinnitus and discharge from
the ear. Removal of the mass is often difficult and general anaesthesia is
frequently required. Initially softening of the mass with sodium bicarbonate
ear drops instilled daily for several days followed by syringeing should be
tried. In order to prevent recurrence an ointment containing salicylic acid,
precipitated sulphur (each 600 mg) and petroleum jelly (30 g) should be
applied frequently to the meatal walls. Regular observation of the patient
is also necessary to prevent further solid accumulations from forming.
FOREIGN BODIES IN THE EAR
Foreign bodies, both animate and inanimate, may be found in the ear. The
latter are much more frequently found, and especially so in children, and
are often introduced by the patients themselves. Inanimate objects may be
divided into those which swell with moisture, such as peas and beans, and
those which do not swell, such as beads, buttons or shells. Foreign bodies
rarely cause any trouble unless the tympanic membrane has been injured,
and they may remain undetected for years. Most complications result from
ill-directed attempts at removal. Gentle inspection will reveal the object in
most cases. If it is not seen the ear may be gently syringed, because a very
small foreign body may lie out of sight in the meatal floor, beyond the isthmus
and close to the drum. When the foreign body is seen and determined not
to be of vegetable composition, removal may be effected by syringeing. The
stream should be directed along that part of the meatal wall where there is
the widest space between it and the foreign body.
While the removal of a foreign body may be easily accomplished when it
has not been driven in by ill-directed interference, great difficulties may be
presented in cases of impaction, or when the object has become swollen
from absorption of fluid, or if the meatal walls have become inflamed. Such
cases are best treated in hospital. In cases of impaction it is sometimes
possible to withdraw the object by means of a fine hook. The use of forceps
is inadvisable except in the case of small or thin objects, because the jaws
of the forceps often cause the foreign body to slide further into the meatus.
Some objects may be removed by suction, a suitable catheter being used.
Attempts at removal of foreign bodies in children should not be prolonged,
because of the pain produced and the fright engendered. In such cases, and
in all cases when the object lies beyond the isthmus, it is wiser to remove
it under a general anaesthetic, often with the use of the operating microscope.
If the walls of the meatus are swollen and bleeding, it is advisable, before
operating, to insert a strip of 12 mm ribbon gauze soaked in a 10 per cent
solution of cocaine hydrochloride to which a few drops of adrenaline hydro-
chloride have been added. Should a diffuse inflammation of the meatus
have been set up by attempts at removal, it may be best to treat the inflam-
mation before attempting removal. In rare instances repeated attempts at
removal may have driven the object into the middle ear, and an external
operation will be required for its extraction.
Animate foreign bodies in the external meatus are rarely met with in
Great Britain, but are found in Eastern countries. Maggots cause intense
pain, and their presence is most likely in an ear where discharge is already